Risk factors for severe complications and salvage management in direct-to-implant immediate breast reconstruction: A retrospective study

Abstract

Controversies regarding the risk factors affecting direct-to-implant (DTI) immediate breast reconstruction still exist. This study aimed to evaluate the risk factors for severe complications in DTI breast reconstruction and explore potential salvage management strategies. We conducted a retrospective review of 238 patients (240 breasts) who underwent DTI immediate breast reconstruction between 2011 and 2020. Multivariate logistic regression analyses were used to identify the risk factors predicting severe complications. Seventeen (7.08%) reconstructed breasts experienced severe complications, of which only 5 were successfully salvaged through surgical revision, while the others failed and resulted in implant removal. Multivariate analyses demonstrated that mesh use [odds ratio (OR) = 4.054, 95% confidence interval: 1.376-11.945, P = .011] and post-mastectomy radiotherapy (odds ratio = 4.383, 95% confidence interval 1.142-16.819, P = .031) were independent predictors of severe complications. Mesh use and post-mastectomy radiotherapy for breast reconstruction increase the risk of severe complications. Despite positive surgical treatment, the successful salvage rate was poor.

Figure 1.

(A) Flap necrosis occurred in a left SSM with DTI reconstruction; (B) wound dehiscence occurred in a left NSM with DTI reconstruction; (C) implant exposure occurred in a right NSM with DTI reconstruction; (D) mesh exposure occurred in a right NSM with DTI reconstruction enveloped by mesh. DTI = direct-to-implant, NSM = nipple-sparing mastectomy, SSM = skin-sparing mastectomy.